2026 Eastern States Conference

Title: Evaluation of Hospitalized Medicine Patient Population Receiving Intravenous Iron Sucrose 

Authors: Olivia Giordano, PharmD; Joseph Berndsen, PharmD

Learning Objective:  Audience members will be able to identify who is indicated for IV iron and who should be getting oral iron. 

Background/Objective: AGA and KDIGO guidelines outline indications for IV vs oral iron. This study evaluates IV iron sucrose use at MHMH, assessing adherence to guideline-based indications and identifying potentially inappropriate IV use.

Methods: This retrospective chart review aims to evaluate the dosing and administration of IV iron sucrose for the treatment of adult patients with iron deficiency anemia (IDA) at Mary Hitchcock Memorial Hospital (MHMH) who were admitted to hospital medicine teams between August 1, 2024 to August 1, 2025. This review will identify how often IV iron is used in patients who could instead receive oral iron. Prescribing trends for IV iron sucrose (ex: dose, frequency) at MHMH will be compared to current guideline recommendations. The patient population evaluated must be >19 years old and have a previous diagnosis of IDA or meet the following lab criteria: Hgb <12 g/dL (women), <13 g/dL (men); ferritin <45ng/mL (stable renal function), <100 ng/mL (CKD); Tsat <20%. Multiple admissions within 30 days were considered one treatment course. Patients that received IV iron sucrose for any indication other than iron deficiency anemia and patients that are pregnant will not be included in this review.

Results: A total of 196 patients were included in the review, of whom 80 (41%) met guideline-based criteria for IV iron therapy per AGA and KDIGO recommendations. Among eligible patients, 31 (38.8%) had stable renal function and 49 (61.2%) had CKD. Among patients meeting AGA criteria, the most common indication was lack of improvement with oral iron (43%), followed by inflammatory bowel disease (29%). Among patients meeting KDIGO criteria, 61% were receiving hemodialysis for stage 5 CKD. Cumulative IV iron sucrose doses greater than 1000 mg occurred in 1.5% of patients with stable renal function and 7% with CKD. Across 460 administrations, 300 mg was the most commonly prescribed dose (72%).

Conclusion/Potential Impact: In this single-center retrospective review, only 41% of patients receiving IV iron sucrose met guideline-based criteria for therapy per AGA and KDIGO recommendations. Variability in dosing practices was also observed, including administration of doses exceeding commonly recommended thresholds. These findings highlight an opportunity to improve inpatient IV iron prescribing through guideline-driven tools and targeted education to promote safer, more evidence-based, and cost-effective care.

Self-Assessment Question: True or false - In hospitalized patients with iron deficiency anemia who can tolerate oral medications, IV iron should be routinely preferred over oral iron due to faster hemoglobin response.

Title: Reducing cangrelor use in the intensive care unit  
Authors: Maliha Akter, PharmD; Nadia Ferguson PharmD, BCPS, BCCCP; Pooja Kumar, PharmD, BCCCP
Learning Objective: At the conclusion of my presentation, the participant will be able to evaluate inappropriate cangrelor prescribing in the intensive care unit (ICU).
Background: Reduce the proportion of ICU cangrelor orders exceeding 0.75 mcg/kg/min by 50% within six months of implementation.
Methods: Create a clinical pharmacist led multidisciplinary intervention to optimize cangrelor use. Establish criteria for ongoing use beyond institutional protocols for PCI and neurointerventional stenting, and for antiplatelet bridging in high-risk patients. Pharmacist-led stewardship activities included daily prospective review of active orders providing recommendations for initiation, de-escalation, or discontinuation of inappropriate orders. With future plans for next steps standardization of algorithm to implement EMR guidance for appropriate timing and dosing of oral P2Y12 inhibitor continuation.
Results: TBD
Conclusion: By creating standardized use criteria and EMR-based decision support, this initiative seeks to mitigate the risks and costs associated with off-label cangrelor use while ensuring safe transitions to oral antiplatelet therapy in high-risk ICU populations.
Self-Assessment Question: What role can pharmacists have in managing inappropriate orders of cangrelor?

Evaluation and Optimization of Sterile Compounding Dispense Prep Compliance
Oleksandra Katrych, Medication Use and Standards, Pharmacy Lead
Timothy J Clark, Pharmacy Resident
Kelly J Miltner, Pharmacy Supervisor for sterile compounding
Learning Objective:
Describe the benefits of a barcode scanning as part of the sterile product preparation process.
Background/Objective
Identify current rates of barcode scanning compliance as part of a computer assisted sterile compounding workflow and develop targeted interventions for improving rates of scanning compliance to ensure proper component selection and improve patient safety.
Methods 
This was a single center, retrospective, quasi-experimental pre–post study evaluating the impact of targeted interventions on the rate of sterile medications prepared that are missing a component barcode scan barcode scanning from April 1, 2025 to May 31, 2025 with a post intervention data set from April 10, 2026 to May 8, 2026. Medication preparations were categorized by medication name and if they were missing one or more component barcode scans. Order data was additionally reviewed to identify if a picture was taken during product preparation that could be used to identify the components that were not scanned.
Results
Among 7398 sterile products prepared during the initial time frame, 57 (0.77%) preparations were identified as missing at least one component barcode scan. The 57 identified preparations were represented by 14 different medications. Of the 57 preparations, 23 (54.39%) did not have an associated image, 3 (5.26%) contained picture but not of the component missing a scan, and the remaining 31 (40.35%) contained images that could be used to positively identify the product that was missing a barcode scan. Four weeks after intervention rates of barcode scanning compliance were found to be 99.57% with 14 preparations being identified out of 3,267 as missing as scan. The missing scans were limited to 3 different products. 
Conclusion(s)
Barcode scanning during sterile product preparation is a reliable way to ensure proper product selection and enhance patient safety. While overall barcode scanning compliance at this institution was above 99%, targeted interventions aimed at medications and channels for reporting identified issues allowed for improvements in scanning compliance and helped identify potential future improvements in product design to ensure ease of barcode scanning.
Self-Assessment Question 
Which of the following is NOT a benefit of barcode scanning technologies?
- Enhanced patient safety
- Improved product selection accuracy
- Decreased product preparation time
- Computerized tracking of products within the electronic health record

Title: Optimizing rabbit anti-thymocyte globulin dosing in kidney transplant patients in a tertiary care transplant center
Authors: Kiera Chibuzor, PharmD; QingXiang Mo, PharmD, BCTXP; Angelly Joy Miane, PharmD; Dhara Shah, PharmD, BCPPPS
Learning Objective: Audience will be able to evaluate the financial impact of switching rabbit anti-thymocyte globulin (rATG) dosing from actual body weight to ideal body weight based
Self-Assessment Question: What body weight do you use when dosing rabbit anti-thymocyte globulin?
Background: rATG is vital for kidney transplant induction immunosuppression. Studies challenge lower exposure to rATG due to risk of infection and malignancy. Some centers adapted ideal body weight dosing as rATG has limited distribution into adipose tissue.
Methods: This performance improvement initiative included adult kidney transplant recipients who received rATG for induction therapy from 3/1/2025-8/31/2025 and 10/1/2025-3/31/2026. Patients transplanted in 9/2025 were excluded due to center's transition from actual to ideal body weight-based rATG dosing during this period. Exclusion criteria included retransplant, positive crossmatch, ABO incompatibility, graft loss, or patient death during index admission. Data collected will include number of rATG vials used per patient pre and post-transplant, donor specific antibodies, percentage of patients with delayed graft function, percentage on dialysis after the first month, kidney biopsy frequency, biopsy-proven acute rejection rate, infection rate, patient survival, and graft survival 6 months post-transplant. The study aims to assess whether ideal body weight-based dosing of rATG is effective for induction while limiting overexposure and cost compared to the actual body weight-based strategy.
Results: A total of 66 patients were included in the pre-transition cohort dosed by actual body weight. On average, each patient used 11 vials of rATG. However, if ideal body weight-based dosing had been applied to this cohort, the average vials used would have decreased to 9 vials per patient, corresponding to an estimated cost savings of $132,000.
Conclusion: While the use of ideal body weight dosing for anti-thymocyte globulin does demonstrate significant cost-saving opportunities, the clinical significance are yet to be determined by comparing the pre- and post-transition cohort.

Title:
Midodrine use in hospitalized patients: a retrospective evaluation of prescribing practices and discharge continuation at a community hospital
Authors:
Harshini D Sobhan, PharmD, MSHS, Ruxandra Necula-Lee, PharmD, Maricelle Monteagudo-Chu, PharmD, BCIDP, BCPS, Shamsul Islam, PharmD, MBA
Learning Objective:
Audience members will be able to evaluate inpatient prescribing practices of midodrine and identify opportunities for optimization of use and improved transitions of care.
Background:
Midodrine is approved for symptomatic orthostatic hypotension, is frequently used off-label. This study evaluates indications, dosing, frequency, and duration of use, comparing new inpatient initiation versus continuation from home and at discharge.
Methods:
Retrospective chart review of adult patients (at least 18years old) admitted to the hospital, with an active inpatient midodrine order during January 1, 2025, to March 31, 2025. Excluded patients were seen in the Emergency Department and not admitted as inpatients, midodrine use less than 24 hours, and those who had additional visits during the study period. Data collected included demographics, indication for use, initiation type, duration of therapy, and discharge continuation. Descriptive statistics summarize patient and prescribing characteristics. Primary outcome is to evaluate the frequency of midodrine use based on indication, distinguishing between new inpatient start and home-medication continuation. Secondary outcome is to evaluate the duration of therapy, continuation of use at discharge and baseline systolic blood pressure prior to first dose for standing hypotension orders. 
Results:
A total of 179 patient charts were reviewed, with 119 patients included. The most common indications for midodrine use were hypotension outside the ICU (59.2%) and ICU hypotension for vasopressor sparing (29.4%). The average duration of therapy was 8.62 days + 9.77. Midodrine was used prior to admission in 31.9% of patients and newly initiated in 68.1%, with 40.7% of new starts occurring in the ICU. Among newly initiated patients, 22.2% continued therapy at discharge, including 12.1% of ICU patients. For hypotension orders outside the ICU, 74.6% were standing and 25.4% were as needed. Among standing orders, 87.2% had a specified systolic blood pressure (SBP) ≤ 120 mmHg, while 12.8%  specified SBP > 120 mmHg prior to start of therapy.
Conclusions:
Midodrine is commonly used to treat hypotension in the ICU and non-ICU settings. In our study, at least 20% of patients who started on midodrine during hospitalization were continued on therapy at discharge. We observed various ranges of blood pressure parameters within midodrine orders outside of the ICU settings, highlighting the importance of improved transitions of care. Further evaluation is needed to determine if standardization of parameters within the midodrine record is warranted.
 
 
Self-Assessment Question
Which pharmacist-driven strategy is best supported by this study to improve safe and appropriate inpatient midodrine use?
A. Encouraging routine continuation of midodrine at discharge for all ICU-started patients
B. Performing medication reconciliation with targeted reassessment of midodrine indication and duration
C. Limiting midodrine initiation to nephrology consults only
D. Avoiding midodrine use in patients with any history of hypotension